Provider Demographics
NPI:1548455181
Name:FEATHERSTONE, WENDY (PA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:FEATHERSTONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:8931 COLONIAL CENTER DR
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7809
Practice Address - Country:US
Practice Address - Phone:239-277-0479
Practice Address - Fax:239-277-0729
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4842622OtherAETNA
FLP01714214OtherRR MEDICARE
FL004510800Medicaid
FLP977772OtherOPTIMUM
FL398587OtherAVMED
FLP1016023OtherFREEDOM
FLP01807184OtherCLEAR HEALTH ALLIANCE
FLQMP000005068262OtherMOLINA
FLY01ZDOtherBCBS
FL1404207OtherWELLCARE-MEDICARE/MEDICAID
FLY01ZDOtherBCBS